Provider Demographics
NPI:1811202351
Name:RAYMOND RICHARD BIXBY MD
Entity Type:Organization
Organization Name:RAYMOND RICHARD BIXBY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BIXBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-823-3231
Mailing Address - Street 1:101 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-2113
Mailing Address - Country:US
Mailing Address - Phone:325-823-3231
Mailing Address - Fax:
Practice Address - Street 1:101 AVENUE J
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:TX
Practice Address - Zip Code:79501-2113
Practice Address - Country:US
Practice Address - Phone:325-823-3231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031EYOtherBLUE CROSS BLUE SHIELD
TX046711003Medicaid
TX046711003Medicaid
TX00948MMedicare Oscar/Certification